Healthcare Provider Details

I. General information

NPI: 1447985692
Provider Name (Legal Business Name): WEST MD PHYSIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9181 MEDCOM ST
NORTH CHARLESTON SC
29406-9168
US

IV. Provider business mailing address

125 W TREMONT AVE UNIT 1010
CHARLOTTE NC
28203-5571
US

V. Phone/Fax

Practice location:
  • Phone: 843-820-7777
  • Fax:
Mailing address:
  • Phone: 330-354-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC WESTERBECK
Title or Position: ATTENDING PHYSICIAN
Credential: MD
Phone: 330-354-9942